下肢创伤后深静脉血栓形成的危险因素及其与D-二聚体的相关性

Correlation between risk factors of deep vein thrombosis in patients with low- extremitytrauma and plasma D-Dimer

目的研究下肢创伤后深静脉血栓(deep vein thrombosis,DVT)的发生率、危险因素及D-二聚体(D-Dimer)水平对DVT的诊断价值。方法回顾性分析我院收治的260例下肢骨折患者的资料,均行彩色多普勒超声检查,以明确有无下肢DVT形成,并统计各类骨折DVT的发生率,对DVT(+)组与DVT(-)组,术前制动时间≥7 d组和术前制动时间<7 d组,男性与女性,高龄组与低龄组患者的D-Dimer浓度及DVT的发生率进行统计学分析。结果下肢骨折总的血栓发生率为12.3%。骨盆骨折中DVT发病率最高(28.57%),足踝部骨折较低(1.54%),创伤后D-Dimer在DVT(+)组的浓度(1527±373)μg/L高于DVT(-)组的(552±262)μg/L(P<0.05)。结论下肢骨折DVT的发生率为12.3%。高龄、高凝因素、卧床时间大于7 d、吸烟史为DVT的危险因素。D-Dimer浓度正常对排除DVT具有重要意义。且卧床时间等因素对其存在影响。

Objective To study the incidence and risk factors of deep vein thrombosis （DVT） in patients with low-extremity trauma and its relation with plasma D-Dimer. Methods We retrospectively analyzed 260 patients with low-extremity fracture. A serial color flow duplex scan was applied preoperatively to determining the presence of DVT, the incidence of DVT was analyzed, and the patients were divided into four groups, based on whether for DVT,the times of immobilization,gender and age, then D-Dimer was analyzed statistically. Results The overall incidence of DVT was 12.3% , among these,fracture of hip was highest（28.57% ） , fracture of foot and ankle was lowest（ 1.54% ）. Plasma D-Dimer level was higher in patients with DVT [ （ 1527 ± 373 ） μg/L] than those without DVT [ （552 ± 262） μg/L ], （ P 〈 0.05 ）. Conclusion The overall incidence of DVT was 12.3%. Higher age, higher energetic injury, more than 7 days immobilization and smoking were risk factors. Normal plasma D-Dimer concentration has important value of exclusion of DVT, and plasma D-Dimer level is affected by the high energy of injury and the time of immobilization.